Department of Neurology, The 2nd Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, China.
Ir J Med Sci. 2019 Nov;188(4):1435-1441. doi: 10.1007/s11845-019-01988-8. Epub 2019 Mar 21.
This study aimed to investigate the effect of nursing aids (NAs) and registered nurses (RNs) mixed nursing staffing model with different ratios on the nursing outcomes and cost in China.
Five thousand and ninety-one patients treated at Neurology and Neurosurgery Center were consecutively recruited in this study and divided into three groups according to the proportion of NAs and RNs: 100% RN group (N = 1756), 90% RN group (N = 1654), and 75% RN group (N = 1681). Nursing outcomes including medication error, unplanned endotracheal tube extubation, bloodstream infection, respiratory tract infection, urinary tract infection, pressure ulcer, ventilator weaning, morality, hospital stay, and nursing cost were recorded.
No difference of patients' characteristics or RNs' characteristics among three groups was observed. Three-group comparison disclosed that medication error, urinary tract infection, ventilator weaning, and nursing cost were different among three groups, while no difference of unplanned endotracheal tube extubation, bloodstream infection, respiratory tract infection, pressure ulcer, mortality, or hospital stay was found. Two-group comparison revealed that medication error and nursing cost were reduced in 75% RN group compared with 90% RN group and 100% RN group, but urinary tract infection was increased while ventilator weaning was decreased in 75% RN group and 90% RN group compared with 100% RN group. Multivariate logistic regression also validated 75% RNs independently correlated with decreased medication error, ventilator weaning, and increased urinary tract infection.
NAs and RNs mixed nursing staffing model with 75% RNs reduces medication error and nursing cost, while increasing urinary tract infection and decreasing ventilator weaning.
本研究旨在探讨不同比例的护理助理（NA）和注册护士（RN）混合护理人员配备模式对中国护理结局和成本的影响。
本研究连续招募了神经内科和神经外科中心的 5091 名患者，根据 NA 和 RN 的比例将患者分为三组：100%RN 组（N=1756）、90%RN 组（N=1654）和 75%RN 组（N=1681）。记录护理结局，包括用药错误、计划性气管插管意外脱出、血流感染、呼吸道感染、尿路感染、压疮、呼吸机撤离、死亡率、住院时间和护理成本。
三组患者的一般资料和 RN 人员特征无差异。三组比较发现，用药错误、尿路感染、呼吸机撤离和护理成本存在差异，而计划性气管插管意外脱出、血流感染、呼吸道感染、压疮、死亡率和住院时间无差异。两组比较发现，与 90%RN 组和 100%RN 组相比，75%RN 组的用药错误和护理成本降低，但尿路感染增加，呼吸机撤离减少；75%RN 组和 90%RN 组的用药错误和护理成本均低于 100%RN 组。多因素 logistic 回归也验证了 75%RN 与用药错误、呼吸机撤离减少和尿路感染增加独立相关。
75%RN 的 NA 和 RN 混合护理人员配备模式可降低用药错误和护理成本，增加尿路感染，减少呼吸机撤离。
